ISHKS TKR The Crux with narration truncated

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C J Thakkar:

C J Thakkar Joint replacement specialist Breach Candy Lilavati Hinduja Hospitals Mumbai Founder member ISHKS cjthakkar52@gmail.com

TKR:

TKR THE CRUX

Total Knee Replacement:

Total Knee Replacement Is a misnomer In reality It is Resurfacing

Total Knee Replacement:

Total Knee Replacement Is more of soft tissue surgery Jigs help to shape the bone Experience helps in ligament balancing

The Crux:

The Crux Restore limb axis Rectangular gaps Equal flexion – extension gaps Patello femoral alignment

Bone cuts in Knee replacement:

Bone cuts in Knee replacement Tibia : Proximal Femur Distal Anterior-Posterior Chamfer Notch cu t Patella

Bone cuts in Knee replacement:

Bone cuts in Knee replacement Extension gap Gap between distal cut surface of femur and proximal cut surface of tibia

Bone cuts in Knee replacement:

Bone cuts in Knee replacement Flexion gap Gap between posterior cut surface of femur and proximal cut surface to tibia

The Crux:

The Crux Restore limb axis Rectangular gaps Equal flexion – extension gaps Patello femoral alignment

PowerPoint Presentation:

Varus knee Valgus knee

Restoration of limb axis:

Restoration of limb axis Cuts Proximal tibial Distal femoral Perpendicular to the mechanical axis of the respective bone

Bone cuts in Knee replacement:

Bone cuts in Knee replacement

Bone cuts in Knee replacement:

Bone cuts in Knee replacement Tibial cut The most common error is to cut the tibia in varus and anterior slope

Bone cuts in Knee replacement:

Bone cuts in Knee replacement Tibial cut How much bone to be resected? 5 mm 10mm up to the defect

Bone cuts in Knee replacement:

Bone cuts in Knee replacement

Tibial cut:

Tibial cut Lower the cut > Weaker the bone Lower the cut > smaller the prosthesis At the most till head of fibula

Femur:

Femur Mechanical axis Centre of head to intercondylar notch

Bone cuts in Knee replacement:

Bone cuts in Knee replacement Distal femoral cut Intra medullary reference 90 degrees to femoral mechanical axis Resect equal to implant thickness

Femur: Mechanical axis:

Femur: Mechanical axis 135 145 120 6 4 8

Femur: Mechanical axis:

Femur: Mechanical axis 135 145 120 6 4 8

Femur: Mechanical axis:

Femur: Mechanical axis 135 145 120 6 4 8

PowerPoint Presentation:

AVN due to Damage to Superior lateral genicular

Test of well done knee:

Test of well done knee Excellent Patellar Tracking

The Crux:

The Crux Restore limb axis Rectangular gaps Equal flexion – extension gaps Patello femoral alignment

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